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Referral Coordinator, UM
- (MEM007955)
Title: Referral Coordinator, UM
Location: Fountain Valley
Department: Utilization Management
Status: Full-time
Shift: Days
Pay Range*: $20.75/hour - $29.47/hour.
At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in Healthcare. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.
Position Summary
The UM Referral Coordinator is responsible for providing technical, administrative, and clerical support for the Utilization Management department, working closely with the Nurse Case Managers and Physician Reviewers. This position creates and assists with the preparation of referral requests. As part of the preparation process will verify eligibility, benefits, request any needed clinical notes and accurately complete or forward referral to higher level of review. Ensures that all referral policies and procedures are followed as required to meet all contractual, regulatory and federal requirements.
Essential Functions and Responsibilities of the Job
1. Research and process incoming referral requests received via fax or Provider Portal generated
2. Check Health Plan eligibility and benefits as needed
3. Gather clinical notes and Health Plan criteria as needed
4. Scan and attach faxed clinical information to referral in system
5. Demonstrate good problem-solving skills
6. Provide a high standard of customer service for Health Plan members, Providers and clinic staff
7. Demonstrates professional and courteous communication skills.
8. Ability to follow company policies, procedures and directives
9. Ability to interact in a positive and constructive manner
10. Ability to prioritize, multitask with attention to detail and timeliness for task completion.
11. Perform any additional duties that may not be inclusive in job description as requested by Management team that is within the scope of knowledge or ability of the Referral Coordinator.
Experience
Education
Full Time
$57k-72k (estimate)
05/06/2024
05/15/2024